Prelim 2

L9 - Case for Health Equity & Quadruple Aim

L10 - Primary Care & Prev

What are 2 definitions for primary care?

• interlinked set of functions delivered for communities in partnership addressing contact access, continuity, coordination, comprehensiveness, & person-centeredness

• generalist team @ front door

What are the 5 Cs (core functions) of primary care?

1. First contact: care/access from drs, PAs, NPs

2. Coordinated: care from other providers for referrals/tests/procedures

3. Continuous: care over large proportion of patient’s health (longitudinal)

4. Comprehensive: care accounts for EBM & patient/family needs/culture

What does each reduce/improve?

1. first contact access reduces unnecessary ED & improve health outcomes

2. long-term care red ED + costs & improve chronic disease management + care quality

3. comprehensive care red costs, speciality visits & improve immunization, prev screening, counseling

4. coordinated care red costs/hosp. & improve referals

*good primary care fit triple aim

States w/higher ratios of PCPs to pop have better health outcomes including _, & more likely to report _. PCP supply positively associated w/increase in _ (inc just 1 PCP = 1.44 fewer premature deaths per 10,000).

dec cancer/heart disease/stroke mortality ; good health ; aggregate life exp

What is prevention 1.0?

downstream strat to provide clinical care & medical interventions

What are USPSTF Recommendation Grades?

*ex: high certainty that net benefit is substantial when women 21-65 screened from cervical cancer

How does prevention 1.0 (USPSTF A & B screenings) deliver real value?

1. improve health outcomes: detect disease early, prev progression, extend healthy life exp

2. improve patient exp: avoid late diagnosis, proactive plan care, build trust

3. red long-term costs: screening less exp (i.e. treating late stage color cancer cost >10x more), shift spending to lower-cost upstream care

Even though we know prev is good, only _ of adults receive rec prevented care

54.9% / half

Why only ~50% good preventive care?

• 42% report not having enough time w/their patients

• spend 13% of day on care coordination & half for activities using med knowledge

What does this show?

show need for team-based care b/c have not enough physicians per # of patients

How might you redisgn workflow to max care team?

If PC works, why is it struggling?

Primary Care Paradox (5 points)

PC is foundational but structurally underinvested in US…

• 50% of visits but <6% of total heath spending

• declining PC workforce

• patients receive only 50% of rec care = quality gaps

• access challenges

• inc workload & admin = physician burnout

How is FFS (how we pay) one explanation for paradox?

• 
  

• providers rewarded for doing more not necessarily better outcomes = burnout (reward vol not value)

How is idea that PC is not OSFA another explanation for paradox?

L13 - Prevention 2.0 Screening